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Barriers and facilitators for interventions to improve ART adherence in Sub-Saharan African countries: A systematic review and meta-analysis

Author

Listed:
  • Amos Buh
  • Raywat Deonandan
  • James Gomes
  • Alison Krentel
  • Olanrewaju Oladimeji
  • Sanni Yaya

Abstract

Background: The HIV/AIDS pandemic remains a significant public health issue, with sub-Saharan Africa (SSA) at its epicentre. Although antiretroviral therapy (ART) has been introduced to decrease new infections and deaths, SSA reports the highest incidence of HIV/AIDS, constituting two-thirds of the global new infections. This review aimed to elucidate the predominant barriers and facilitators influencing ART adherence and to identify effective strategies to enhance ART adherence across SSA. Methods: A comprehensive review was conducted on studies examining barriers to ART adherence and interventions to boost adherence among HIV-positive adults aged 15 and above in SSA, published from January 2010 onwards. The research utilized databases like Medline Ovid, CINAHL, Embase, and Scopus. Included were experimental and quasi-experimental studies, randomized and non-randomized controlled trials, comparative before and after studies, and observational studies such as cross-sectional, cohort, prospective and retrospective studies. Two independent reviewers screened the articles, extracted pertinent data, and evaluated the studies’ methodological integrity using Joanna Briggs Institute’s standardized appraisal tools. The compiled data underwent both meta-analysis and narrative synthesis. Results: From an initial pool of 12,538 papers, 45 were selected (30 for narrative synthesis and 15 for meta-analysis). The identified barriers and facilitators to ART adherence were categorized into seven principal factors: patient-related, health system-related, medication-related, stigma, poor mental health, socioeconomic and socio-cultural-related factors. Noteworthy interventions enhancing ART adherence encompassed counselling, incentives, mobile phone short message service (SMS), peer delivered behavioural intervention, community ART delivery intervention, electronic adherence service monitoring device, lay health worker lead group intervention and food assistance. The meta-analysis revealed a statistically significant difference in ART adherence between the intervention and control groups (pooled OR = 1.56, 95%CI:1.35–1.80, p =

Suggested Citation

  • Amos Buh & Raywat Deonandan & James Gomes & Alison Krentel & Olanrewaju Oladimeji & Sanni Yaya, 2023. "Barriers and facilitators for interventions to improve ART adherence in Sub-Saharan African countries: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 18(11), pages 1-36, November.
    • Handle: RePEc:plo:pone00:0295046
    DOI: 10.1371/journal.pone.0295046
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    References listed on IDEAS

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    1. Nozipho Becker & Krishna C Poudel & Lorraine S Cordeiro & Aline G Sayer & Thokozile E Sibiya & Lindiwe N Sibeko, 2021. "A quantitative analysis of food insecurity and other barriers associated with ART nonadherence among women in rural communities of Eswatini," PLOS ONE, Public Library of Science, vol. 16(8), pages 1-16, August.
    2. repec:plo:pmed00:1002183 is not listed on IDEAS
    3. Panmial Priscilla Damulak & Suriani Ismail & Rosliza Abdul Manaf & Salmiah Mohd Said & Oche Agbaji, 2021. "Interventions to Improve Adherence to Antiretroviral Therapy (ART) in Sub-Saharan Africa: An Updated Systematic Review," IJERPH, MDPI, vol. 18(5), pages 1-21, March.
    4. Samuel Muhula & John Gachohi & Yeri Kombe & Simon Karanja, 2022. "Interventions to improve early retention of patients in antiretroviral therapy programmes in sub-Saharan Africa: A systematic review," PLOS ONE, Public Library of Science, vol. 17(2), pages 1-26, February.
    5. Julius Y Fonsah & Alfred K Njamnshi & Charles Kouanfack & Fang Qiu & Dora M Njamnshi & Claude T Tagny & Emilienne Nchindap & Léopoldine Kenmogne & Dora Mbanya & Robert Heaton & Georgette D Kanmogne, 2017. "Adherence to Antiretroviral Therapy (ART) in Yaoundé-Cameroon: Association with Opportunistic Infections, Depression, ART Regimen and Side Effects," PLOS ONE, Public Library of Science, vol. 12(1), pages 1-19, January.
    6. repec:plo:pone00:0046909 is not listed on IDEAS
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